Single port laparoscopic access system with external tool support

ABSTRACT

A system for performing single port laparoscopic procedures includes a deployment frame and a plurality of tools. The tools are pivotally mounted on the frame and have end effectors which are translatably and rotatably disposed in the tool. A handle at the proximal end of the tool controls an end effector at the distal end of the tool. Movement of the tools relative to the frame is constrained so that they remain in a fixed geometric relationship which prevents the tools from interfering with each other during laparoscopic procedures.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/491,990 (Attorney Docket No. 41628-712.201), filed Sep. 20, 2014, thecontent of which is fully incorporated herein.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present invention relates generally to medical systems, tools, andmethods. More particularly, the present invention relates to systems andtools for single port laparoscopic access, typically for access throughincisions or the umbilicus.

2. Description of the Background Art

In recent years, many open surgical procedures performed in theabdominal cavity have been replaced by minimally invasive proceduresperformed through several very small incisions using an endoscope,referred to as a laparoscope, inserted through one of the incisions. Theother incisions are used for introducing surgical tools, and theabdominal cavity is inflated to create a space for performing thesurgery. Such procedures are commonly called “laparoscopic”, and can beused for gallbladder removal, hernia repair, hysterectomy, appendectomy,gastric fundoplication, and other procedures. Similar endoscopic,thoracoscopic and other procedures are performed in other body cavitieswithout inflation.

While a great advance over open surgical procedures, which can requirean incision of several inches or more through the abdominal wall, suchlaparoscopic procedures still require incisions through muscle or fasciain several separate sites. Each incision may increase the risk ofinfection, bleeding trocar site hernia, increased postoperative pain,compromised cosmetic result and other adverse events for the patient.

As an improvement over such laparoscopic procedures, “single port”laparoscopy has been proposed where a single access port is insertedthrough the umbilicus (the patient's navel). Access solely through theumbilicus is advantageous since it provides a superior cosmetic result.Introducing the laparoscope and all other tools necessary for thesurgery through a single port, however, makes performance of theprocedures more difficult. In particular, the use of conventionallaparoscopic tools, which are typically straight, makes it difficult toapproach a single target area in the treated tissue with two or moretools at the same time.

A further improvement in the field of single port laparoscopic surgeryis described in U.S. Patent Publication 2012/0116362, commonly assignedwith the present application. A system for performing single portlaparoscopic procedures includes a transcutaneous seal and a pluralityof tools. The tools comprise a substantially rigid tubular seal having acore which is translatably and rotatably disposed in the sleeve. Thehandle at the proximal end of the tool controls an end effector at thedistal end of the tool. The sleeves of the tools are locked in thetranscutaneous seals so that they remain in a fixed geometricrelationship which prevents the tools from interfering with each otherduring laparoscopic procedures. While functional and a significantadvance in the art, mounting of the tools within the transcutaneous sealcan be a challenge.

Thus, it would be a benefit to provide further improved systems andtools for laparoscopic access through single ports for performingminimally invasive surgical procedures. It would be particularlydesirable if the tools and other system components were able tofacilitate access to target sites and reduce the likelihood that thetools would interfere with each other during the performance of theprocedures. In particular, such tools and systems should further allowthe physician to intuitively manipulate the tools, while viewing theprocedure on the video display, in a manner similar to performance usingmore conventional multi-port laparoscopy procedures. Still further, suchlaparoscopic access systems should provide improved structures andmethods for supporting the tools relative to the transcutaneous sealwith minimum interference and maximum open port area. At least some ofthese objectives will be met by the inventions described hereinafter.

SUMMARY OF THE INVENTION

In a first aspect of the present invention, a laparoscopic tool systemcomprises a frame having a periphery and a central opening in ahorizontal plane. The frame is configured to be positioned over atranscutaneous incision, such as an incision in a patient's abdomen,typically an umbilicus. First and second tools are pivotally attached atfirst and second locations on an exterior surface of the frame,typically on a periphery of the frame, respectively. A mid-portion ofeach tool passes through the central opening of the frame, and the toolsare attached to the frame so that they each pivot in at least twovertical planes relative to the frame. In particular, the mid-portion ofeach tool is positioned to avoid interference between the tools as thetools are pivoted in said at least two vertical planes.

In specific embodiments, the frame comprises a continuous peripherysurrounding the central opening, typically a circular ring. Each toolusually has proximal and distal sections which lay along a common axiswhich passes outside (or in some cases inside) the periphery of theframe. The frame may have variety of sizes so the axes of the proximaland distal sections of the tool may pass outside or within the frame.The distal and proximal sections are typically configured to telescopeto accommodate extension and retraction of the actuator and effector,and the mid-portions of each tool are preferably semi-circular andextend radially inwardly from the common axis of the proximal and distalsections.

The tools may be constructed generally as described in in U.S. PatentPublication 2012/0116362, the full disclosure of which is incorporatedherein by reference, particularly as illustrated in FIGS. 11-16. Thetools in the present invention, however, do not require the receivingtubes which allow direct coupling of the tools to each other as taughtby the prior patent publication. In the present invention, at least onetool will include an effector at a distal end thereof, an actuator at aproximal end thereof, and a core passing therethrough which mechanicallycouples the actuator to the effector so that the actuator may beextended and retracted relative to the mid-portion to extend and retractthe effector.

In a second aspect of the present invention, a laparoscopic tool systemcomprises a transcutaneous incision seal having one end configured toreside on an interior side of an incision, a second end configured toreside on an exterior side of the incision, and sheath extending betweenthe ends to protect the incision. A ring has a central opening, a lowersurface, and an exterior periphery, wherein the lower surface isconfigured to removably attach to the second end of the transcutaneousincision seal. A first rocking attachment block is attached to pivotabout a first horizontal axis through the ring, and a first verticalsupport arm is attached to pivot about a second horizontal axis throughthe first rocking attachment block. A second rocking attachment block isattached to pivot about a third horizontal axis through the ring, and asecond vertical support arms attached to pivot about a fourth horizontalaxis through the second rocking attachment block. A first tool isremovably attached to the first vertical support arm and has distal andproximal sections which are aligned along an axis passing through anintersection of the first and second horizontal axes. A second tool isremovably attached to the second vertical support arm and has distal andproximal sections which are aligned along an axis passing through theintersection of the third and fourth horizontal axes.

In specific embodiments, the first and second rocking attachment blocksare connected to the exterior periphery of the ring. Such exteriorattachment is a particular advantage as it reduces the structure thatoccupies the central opening of the ring. In particular, by removablyattaching the tools to the upper ends of the arms, only the mid-portionswill pass through the central opening of the ring or other supportframe. The first and third horizontally axes are usually axially alignedand the first and second rocking attachment blocks are usually onopposite sides of the ring. The first and second vertical support armsare typically attached to the first and second rocking attachmentblocks, respectively, and the second and fourth horizontal axes areparallel but spaced horizontally apart from each other.

In further specific embodiments, each tool preferably has asemi-circular mid-portion which passes through the central opening ofthe ring, wherein the midsections are positioned to avoid interferenceas the tools are independently pivoted about all four horizontal axes,and at least one tool usually comprises an effector at a distal endthereof, an actuator at a proximal end thereof, and core passingtherethrough which mechanically couples the actuator to the effector.The core is typically translatable within said seal at least one tool sothat the actuator may be extended and retracted relative to themid-portion to extend and retract the effector, and the distal andproximal sections are configured to telescope to accommodate extensionand retraction of the actuator and effector.

The tool movement can be broken down into three specific types: (1)up/down or pivotal about a first horizontal axis, (2) medial/lateral orpivotal about a second horizontal axis orthogonal to the firsthorizontal axis, and (3) in/out in an axial direction through the tool.During medial and lateral movement of the tool, the semicircular segmentmoves along the circumference of a virtual circle where the attached armis pivoted at the center of this circle. This mechanism assures that thedistance of both tools within the umbilicus will not change during themedial and lateral displacement of the handle/effector. During thein/out movement.

In a third aspect of the present invention, methods for performinglaparoscopic surgery through a single port comprise securing a framehaving a central opening over an incision in a patient's abdomen todefine the single port. A first tool is attached to a first pivotalattachment element at a first location on an outer periphery of theframe, and a second tool is attached to a second pivotal attachmentelement at a second location on the outer periphery of the frame. Eachtool has distal and proximal sections which lie on axes passing throughthe pivotal attachment elements and mid-portions which remain positionedwithin the central opening of the frame but avoid interference as thetools are manipulated by a user during a surgery.

In specific embodiments of the methods, one of the first and secondtools detached from the pivotal attachment element, and a third tool isattached to the respective pivotal attachment element, wherein the thirdtool has distal and proximal sections which lie on an axis passingthrough the pivotal attachment element and a mid-portion which remainspositioned within the central opening of the frame as the tools aremanipulated by a user during the surgery. The proximal ends of the toolsare typically manipulated to pivotally position the distal sections atdesired locations within a surgical field, and the proximal ends of thetools may be axially extended and retracted to axially extend andretract the distal sections, typically to position an end effector at adesired location in the surgical field.

INCORPORATION BY REFERENCE

All publications, patents, and patent applications mentioned in thisspecification are herein incorporated by reference to the same extent asif each individual publication, patent, or patent application wasspecifically and individually indicated to be incorporated by reference.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe appended claims. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1 is a side view of a system constructed in accordance with theprinciples of the present invention including first and second toolspivotally mounted to a support frame with a repositioned view of one ofthe tools shown in broken line.

FIG. 2 is a side view of the system of FIG. 1.

FIG. 3 is a detailed, perspective view illustrating the pivotalattachment of a rocking attachment block to the tool support frame and asecond pivotal attachment point of a vertical support arm to the rockingattachment block.

FIGS. 4A and 4B illustrate pivoting or rotation of the support arm inorthogonal planes relative to the tool attachment frame.

FIG. 5 is a detailed view illustrating the separability of a toolattachment block which forms part of each laparoscopic tool to thevertical support arm which is coupled to the tool support frame.

FIG. 6 is a top view of the laparoscopic tool system 10 of the presentinvention showing generally how a physician would view the system duringuse.

FIG. 7 is an exploded view of an exemplary embodiment of a tool usefulin the laparoscopic tool system of the present invention.

FIG. 8 illustrates a transcutaneous seal which is useful for attachmentof the laparoscopic tool system of the present invention.

FIG. 9 illustrates the transcutaneous seal of FIG. 8 in place through anincision in a patient's umbilicus further illustrating attachment of thelaparoscopic tool system in broken line.

DETAILED DESCRIPTION OF THE INVENTION

Referring now to FIGS. 1 and 2, a laparoscopic tool system 10constructed in accordance with the principles of the present inventioncomprises a tool attachment frame 12 having a first tool 14 and a secondtool 20 pivotally attached thereto. The first tool has a mid-portion 16and the second tool has a mid-portion 22, and both mid-portions extendgenerally inwardly from an axis 28 of the tool, as best illustrated inFIG. 7. Both mid-portions 16 and 22 are preferably circular and have aradius r emanating from a virtual rotation point p, which is also bestseen in FIG. 7. The virtual rotation point p is generally aligned with apivoting assembly attached to an outer periphery of the tool attachmentframe 12, as will be described in more detail hereinbelow with referenceto FIGS. 3, 4A and 4B. Having the virtual rotation points of each toollocated outside the periphery of the ring allows the generally circularmidportions 16 and 22 to pass and move through the central opening 18 ofthe frame 12 without interfering with each other. While the mid-portions16 and 22 could alternatively have non-circular geometries which extendradially inward relative to the frame 12, for example being oval orpolyhedral, the circular shape causes the passage point of themid-portion to remain fixed within the central opening 18 of the frameso long as the tool is constrained to move in to orthogonal planes bythe pivot attachment as will be explained in more detail hereinafter.

Each tool 14 and 20 includes a proximal section 24 and distal section26. These proximal and distal sections are generally straight and liealong a common axis 28 (FIG. 7) which is generally not aligned with thevirtual pivot point P. Thus, the mid-portions 16 and 22 of the tools 14and 20 will generally circumscribe less than 180° of a full circle,typically circumscribing approximately 120°.

In preferred embodiments, both the proximal section 24 and the distalsection 26 of each tool will have a telescoping configuration whichallows axial extension and retraction of the tool during a procedure, aswill be described in greater detail hereinafter with reference to FIG.7.

Referring now to FIGS. 3, 4A, and 4B, a rocking attachment block 52 ispivotally secured to the tool attachment frame 12 to rotate about afirst axis 64, as shown in broken line. The rotational direction isshown by arrow 66. The pivot or rotation point 58 is best seen in FIGS.4A and 4B.

A vertical support arm 54, in turn, is pivotally attached to the rockingattachment block 52 to pivot or rotate about a second axis 68, as shownby arrow 70. In this way, the vertical support arm 54 is able to pivotin two orthogonal planes relative to the vertical plane defined by thetool attachment plane 12. As mentioned previously, the constraint of thevertical support arm to pivot or rotate in two orthogonal planes limitsmovement of the circular mid-portions 16 and 22 of the first and secondtools 14 and 20, respectively, so that they always pass through the samelocation within the circular opening 18 of the tool attachment frame 12.While it would also be possible to use a single, universal jointattaching the vertical support arm 54 to the tool attachment 12, theadditional degrees of freedom of motion would allow the mid-portions ofthe tools to wobble side-to-side within the circular opening, thusincreasing the chances of interference of the tools and unintendedengagement of the inner periphery of the tool attachment frame 12.Referring again to FIGS. 4A and 4B, the motion of the vertical supportarm 54 relative to axis 64 can be seen in broken line. Similarly,referring to FIG. 4B, the motion of vertical support arm 54 relative tothe second axis 68 is seen in broken line.

Referring now to FIG. 5, it will be desirable to exchange the toolsduring the performance of any particular laparoscopic procedure, and avariety of different tools will be available. Such interchangeabilitycan be conveniently achieved by providing a tool attachment block 60 oneach of the tools 14 and 20. Conveniently, the tool attachment block 60may be attached toward the upper end of the mid-portion 22 so that theattachment point with the vertical support arm is raised verticallyabove the frame 12 by a maximum distance. By moving the attachment pointvertically upward, the unencombered length of the mid-portion 16 or 22is increased, allowing maximum rotation of the tool in and out of thecentral opening 18 of the support frame 12.

Referring now to FIG. 6, the tool support frame 12 is convenientlyformed as a circular ring with a circular central opening 12.Conveniently, an arrow 72 or other indicator will allow a user to orientthe tool system 10 relative to the target site within the abdomen orother body cavity to be treated. Conveniently, the arrow will be pointeddirectly at the target region so that the tools 14 and 16 are alignedalong the line which is generally perpendicular to the direction towardthe intended surgical site. In this way, the tools will be generallyequidistant to the target site and manipulation of the tools will bemore intuitive.

An exemplary construction of a tool 16, 22 is shown in FIG. 7. The toolof FIG. 7 will have forceps or other scissors-like end effector 32′which is actuated by a pivoting handle 30′. The handle 30′ will operateby pulling pull wire 38 which passes through a central lumen of aflexible cable 36. The assembly of the flexible cable 36 and pull wire38, in turn, is located within a luminar central passage of the tool16/22. The length of the cable 36 will be fixed and will equal thelength of the tool 16/22 with one of the telescoping hands fullyextended and the other fully contracted. In this way, pushing andpulling on the actuator 30 relative to the mid-portion 16/22 of the toolwill cause one of the telescoping sections to elongate while the otherforeshortens. Each telescoping section, however, will be able to coverand maintain axial rigidity for the cable 36 and wire 38 so that thetool maintains alignment along the axis 38 (with the exception of thecircular midsection). Such tool construction is generally described inU.S. patent publication 2012/0116362, the full text of which has beenpreviously incorporated herein by reference.

It should be noted, however, that the present invention can accommodatea wide variety of more and less complicated laparoscopic tools. Forexample, simple electrocaudiry tools may be provided having the axialgeometry with offset circular midsection, as shown in all previousfigures. There would be no need to provide any core, however, as asimple electrical conductor can be utilized within the interior of thetool in order to extend and retract the tool as just described. Othertool configurations will also be capable of being implemented within thesystems of the present invention.

Referring now to FIG. 8, a transcutaneous seal 42 comprises an upper forring 44 and a lower end or ring 46. A flexible sheath 48 extends betweenthe upper and lower ends. The seal may be disposed in a transcutaneousincision TI through and abdominal wall AW, as shown in FIG. 9.Conveniently, the sheath 48 may be generally elastic, and the length ofthe sheath may be adjusted by rolling the sheath over either the upperor lower rings, allowing the transcutaneous seal to be stretched andplaced over the transcutaneous insertion TI.

As shown in FIG. 9, once in place, the tool attachment frame 12 may beattached to the upper end or ring 44 of the transcutaneous seal 42, thusfixing the frame in place relative to the patient. The tools 14 and 20may then be attached to the vertical support arms 54 and the tools thenused to perform a laparoscopic procedure by manipulating the proximalends of the tools to reposition the distal ends where desired. As theprocedure progresses, the tools may be interchanged for other tools bysimply detaching the tool attachment blocks 60 from the vertical supportarms 54.

What is claimed is:
 1. A laparoscopic tool system comprising: a framehaving a periphery and a central opening in a horizontal plane, saidframe being configured to lie over a transcutaneous incision; a firsttool pivotally attached to an exterior of the frame at a first location,wherein a mid-portion of the first tool passes through the centralopening of the frame; and a second tool pivotally attached to anexterior of the frame at a second location, wherein a mid-portion of thesecond tool passes through the central opening of the frame; wherein thetools pivot in at least two vertical planes relative to the frame andwherein the mid-portions of the tools are positioned to avoidinterference as the tools are pivoted in said at least two verticalplanes.